Topology-Optimized Splints vs Casts for Distal Radius Fractures

Key Points Question Is a topology-optimized splint more effective than traditional cast therapy in reducing wrist pain and enhancing wrist function for patients with distal radius fractures, including those who did and did not undergo closed manual reduction? Findings In this randomized clinical trial involving 110 participants with distal radius fractures, the intervention group received topology-optimized splint immobilization and the control group received cast immobilization after closed manual reduction for 6 weeks. The topology-optimized splint group exhibited better wrist functional outcomes than the traditional cast group for the treatment of distal radius fractures, with no clinically significant difference at 12 weeks of follow-up. Meaning The results suggest that the topology-optimized splint provides early relief from pain and improved function for patients, offering effective treatment while mitigating the risks associated with surgery.


Introduction
This rehabilitation program is designed for patients with distal radius fractures to provide a comprehensive and systematic set of rehabilitation guidelines after immobilization removal.This program emphasizes individual differences, which patients need to adjust according to their own circumstances.

Rehabilitation (HAND/WRIST/EBLOW/SHOULDER)
HAND / WRIST -Make fists Make a fist with both hands, then relax.
Repeat this exercise 15 times, for at least 3 sessions each day (or exercise with a stress ball).

HAND / WRIST -Active Flexion/Extension
Place your arms on the  Repeat this exercise 15 times, for at least 3 sessions each day.

eAppendix 2. Splint and Cast Technique Methods
Splint technique methods: In this study, we developed a mathematical model for the splint, considering its geometry, material properties, external loads, and boundary conditions.Then, we utilized a topology optimization algorithm to optimize the plywood structure based on predefined goals (e.g., maximizing stiffness, minimizing weight) and constraint conditions (e.g., material usage (polyamide, PA12), manufacturing process).By iteratively calculating, we successfully reduced unnecessary material while meeting design requirements, resulting in a lighter and more efficient plywood.To evaluate the performance of the optimized structure, we employed the finite element method for simulation and analysis.Finally, the splint body was manufactured using multi-jet fusion 3D printing technology.In order to facilitate the quick application of splints to clinical patients with distal radius fractures, we have developed 4 different sizes of prefabricated topology-optimized splints.These splints are designed to meet the majority of patient needs.However, for certain special patients, such as individuals with larger body frames or very thin individuals, the prefabricated splints may not be suitable.In such cases, we offer Repeat this exercise 15 times, for at least 3 sessions each day.HAND / WRIST -Active Radial Deviation/Ulnar Deviation Start with your palms down and turn your palms outward with the back of your hands facing up.Start with your palms down and turn your palms inward with the back of your hands facing up.Repeat this exercise 15 times, for at least 3 sessions each day.HAND / WRIST -Active Supination/Pronation With elbows at sides, alternate turning hands palm-up and palm-down.Repeat this exercise 10 times, for at least 3 sessions each day.SHOULDER -Shoulder PinchPull shoulders forward, backward, abduction, adduction, external rotation, and internal rotation, pinching shoulder blades together.(Hold5 seconds.Relax.)Repeat this exercise 15 times, for at least 3 sessions each day.ELBOW -Elbow AROMStanding or siting, bend both arms to touch your shoulders, then return to your side.
customized topology-optimized splints.Cast technique methods: To begin, gather the necessary materials: cast bandage, paper cotton, and water.Start by wrapping the forearm with © 2024 Ma H et al.JAMA Network Open.
paper cotton.Next, reinforce cast bandage on the dorsal or palmar skin, depending on the actual situation of fracture displacement.Finally, the cast was applied over the skin to immobilize the fracture, extending from below the elbow to the metacarpals.eAppendix 3. Clinical Photos and Radiographs a: Model of splint b: Solid image c: Wearing image of patient 1 d: After removal image of patient 2 c: Material of cast f: Model of cast immobilization g: Wearing image of patient 3 h: After removal image of patient 4 table, palms together, elbows on the table slowly spread arms apart.
© 2024 Ma H et al.JAMA Network Open.